160 Ocean Avenue West Complaint 7-11-2019 ?r .' CITY OF SALEM, MASSACHUSETTS
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BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN 4)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: , _ Received By: S
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Complaint Number: 2489
Complainant Nil f clk RL149-r
Address: '.�,6 0 eaA ftVr,ovr- Phone:
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Investigated.By: Date: _
Property Owner/Occupant Name _Telephone #: